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This document is a form for individuals to elect Oregon state continuation coverage under the American Recovery and Reinvestment Act and provides details on eligibility and requirements for continuation

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How to fill out state continuation election premium

How to fill out State Continuation Election / Premium Subsidy Attestation

01

Gather all necessary personal and health insurance information.

02

Obtain the State Continuation Election / Premium Subsidy Attestation form from your state’s insurance department or your employer.

03

Carefully read the instructions included with the form.

04

Fill out your personal details such as name, address, and contact information in the designated fields.

05

Provide the required information about your previous health insurance coverage.

06

Indicate whether you wish to elect continuation coverage or apply for premium subsidies where applicable.

07

Sign and date the form to certify the information provided is accurate.

08

Submit the completed form to the appropriate entity as instructed, either by mail or online.

Who needs State Continuation Election / Premium Subsidy Attestation?

01

Individuals who recently lost their group health insurance coverage due to employment changes.

02

Employees and their dependents eligible for continued health coverage under state law.

03

People seeking premium subsidies to aid in the payment of health insurance premiums.

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What is State Continuation Election / Premium Subsidy Attestation?

State Continuation Election is a provision that gives eligible individuals the option to continue their health insurance coverage under certain state-specific laws, typically after a qualifying event. Premium Subsidy Attestation refers to the requirement for individuals seeking premium subsidies to attest their eligibility based on specific income and enrollment criteria.

Who is required to file State Continuation Election / Premium Subsidy Attestation?

Individuals who have lost their health insurance coverage due to qualifying events, such as job loss or reduction in work hours, and who wish to continue their coverage under state laws or apply for premium subsidies must file the State Continuation Election / Premium Subsidy Attestation.

How to fill out State Continuation Election / Premium Subsidy Attestation?

To fill out the State Continuation Election / Premium Subsidy Attestation, individuals need to provide personal information such as their name, address, and the details of their previous coverage. They must also indicate their eligibility for continuation and any premium subsidy they are applying for, along with any required income documentation.

What is the purpose of State Continuation Election / Premium Subsidy Attestation?

The purpose of the State Continuation Election / Premium Subsidy Attestation is to ensure individuals can maintain their health insurance coverage during periods of transition and to verify their eligibility for financial assistance programs that can help with premium costs.

What information must be reported on State Continuation Election / Premium Subsidy Attestation?

The information that must be reported includes the individual's personal details, previous health insurance plan information, the reason for coverage loss, income details to assess eligibility for subsidies, and any other state-specific requirements pertinent to the continuation of coverage.

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